Comparative study between epidural morphine versus epidural morphine-haloperidol combination for post thoracotomy pain relief Ayman M. Abdel Ghaffar (1) and Wesam Abdel Galil (2)

Background:  The addition of haloperidol to epidural morphine has been assumed to provide good analgesia following severely painful operations including thoracotomy with subsequent decrease in the analgesic consumption. Reduction in the incidence and severity of pruritis, postoperative nausea and vomiting (PONV) could be achieved without cardiac, respiratory or central nervous system side effects.

Objective: This study was to evaluate the effect of haloperidol on the incidence and severity of pruritus, PONV caused by epidural morphine as well as its effect on urinary retention and sedation, besides evaluating its effect on the duration and potency of morphine analgesia as an attempt to improve the quality of postoperative analgesic condition of patients undergoing thoracotomy.

Methods: In our study, 60 patients were scheduled for elective thoracic surgery and were allocated into two equal groups; 30 patients each. Morphine group MG where (5 mg) morphine was given epidurally and Morphine-haloperidol group MHG where (5 mg) morphine plus (2.5 mg) haloperidol given epidurally. The severity of pruritis, PONV, pain and sedation were evaluated at (1, 6, 12 & 24 hours) postoperatively by an anesthesiologist who is blinded to the study.

Results: Along the 24 hours postoperative period study, no significant differences were detected between both groups as regard the respiratory rate and the hemodynamic values. However a significant decrease in the incidence and severity of the unwanted side effects of epidural morphine like pruritis, PONV on addition of haloperidol to epidural morphine in the second group. No significant difference was observed between both groups as regard the  postoperative urinary retention. Although the analgesic quality did not show a significant difference between the two groups by visual analogue scale (VAS), significant reduction in the analgesic consumption was observed in the haloperidol group together with significant decrease in the cortisol level in the same group. All patients in the haloperidol group had experienced mild to moderate degree of sedation.

Conclusion: This study concluded that, adding haloperidol to epidural morphine when certain safety measures are taken is  safe, feasible and helpful technique for better postoperative analgesia,  lesser  analgesic consumption and significantly decrease the unwanted side effects of epidural morphine for adult patients undergoing thoracotomy